Provider Demographics
NPI:1922362326
Name:BERGAGLIO, ANDREA (MS,ED)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:BERGAGLIO
Suffix:
Gender:F
Credentials:MS,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1606
Mailing Address - Country:US
Mailing Address - Phone:631-544-0708
Mailing Address - Fax:
Practice Address - Street 1:56 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-1606
Practice Address - Country:US
Practice Address - Phone:631-544-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist